Provider Demographics
NPI:1194989236
Name:BRUCE E JOHNSON MD
Entity type:Organization
Organization Name:BRUCE E JOHNSON MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:E
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-282-0044
Mailing Address - Street 1:7605 FOREST AVE
Mailing Address - Street 2:SUITE 316
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-4938
Mailing Address - Country:US
Mailing Address - Phone:804-282-0044
Mailing Address - Fax:804-287-4317
Practice Address - Street 1:7605 FOREST AVE
Practice Address - Street 2:SUITE 316
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-4938
Practice Address - Country:US
Practice Address - Phone:804-282-0044
Practice Address - Fax:804-287-4317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101027023207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA57743OtherSOUTHERN HEALTH
VA93234OtherMAMSI
VA2532231OtherAETNA
VA140760OtherANTHEM BCBS
VA6215891Medicaid
VA027122OtherCIGNA
VA48006OtherSENTARA
VA2532231OtherAETNA
VA6215891Medicaid